Feasibility and preliminary efficacy of the Balance Program to reduce pain-related disability in pediatric sickle cell disease

Authors

Megan E. Connolly, Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Sydney Forman, Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA.
Christina M. Sharkey, Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA.
Stephanie Merwin, Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Deepika S. Darbari, Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA.
Steven J. Hardy, Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

9-19-2023

Journal

Pediatric blood & cancer

DOI

10.1002/pbc.30667

Keywords

Acceptance and commitment therapy; cognitive-behavioral therapy; pain; pediatric; sickle cell disease

Abstract

BACKGROUND: Sickle cell disease (SCD) pain is associated with functional impairment, and treatment is often limited to pharmacological approaches with unwanted side effects. Although behavioral interventions exist for non-SCD pain populations, interventions designed to address pain-related impairment in SCD are lacking. METHODS: Twenty youth (9-17 years) with SCD completed a four-week telemedicine pain intervention (NCT04388241). Participants and caregivers completed baseline and post-intervention PROMIS pain measures and the Treatment Evaluation Inventory-Short Form (TEI-SF). Descriptive analyses assessed feasibility and acceptability. Reliable Change Index analyses assessed for significant post-intervention changes in pain functioning. Paired t test analyses compared baseline and post-intervention opioid prescription fills. RESULTS: All participants completed at least one treatment session. Eighteen (90%) youth completed all sessions. Youth (100%) and caregivers (94%) rated the intervention as moderately or highly acceptable on the TEI-SF. Forty-seven percent of caregivers and 44% of youth reported reliably significant improvements in pain interference after the intervention (median T-score differences: 24.8 and 23.5, respectively). Sixty-five percent of caregivers (T-score improvement difference: 19.3) and 31% of youth (T-score improvement difference: 32) reported improvements in pain behaviors. There was no significant difference in opioid prescription fills pre- and post-intervention (P > 0.05). CONCLUSIONS: The Balance Program is feasible, highly acceptable, and can be delivered remotely to reduce barriers to care. Approximately half of youth and caregivers reported significant declines in pain interference following the intervention, with substantial improvements in functioning for treatment responders. Behavioral pain interventions are important adjunctive treatments to uniquely address functional impairment associated with acute and chronic pain in SCD.

APA Citation

Connolly, Megan E.; Forman, Sydney; Sharkey, Christina M.; Merwin, Stephanie; Darbari, Deepika S.; and Hardy, Steven J., "Feasibility and preliminary efficacy of the Balance Program to reduce pain-related disability in pediatric sickle cell disease" (2023). GW Authored Works. Paper 3379.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3379

Department

Pediatrics